title: Is preoperative brain midline shift a determinant factor for neurological improvement after cranioplasty?
abstract: OBJECTIVE
  In patients with traumatic brain injury, the degree of brain midline shift is related to prognosis. In this study, we evaluated the impact of the presence of a preoperative brain midline shift on the Glasgow Coma Scale (GCS) scores and muscle power (MP) improvement after cranioplasty.
  
  
  METHODS
  In this 6-year retrospective cohort study, we compared cranioplasty patients from Taiwan with and without a preoperative brain midline shift. We assigned the patients to the following two groups: the midline shift group and the nonmidline shift group. The GCS score and MP contralateral to the lesion site were recorded and analyzed both prior to and 1 year after the operation.
  
  
  RESULTS
  We enrolled 56 cranioplasty patients (35 patients with a midline shift and 21 without a midline shift) and analyzed their complete clinical characteristics. There were significant improvements in the GCS (p = 0.0078), arm MP (p = 0.0056), and leg MP (p = 0.0006) scores after cranioplasty. There was also a significant improvement in the GCS score in the brain midline shift group (0.4 ± 0.149 in the brain midline shift group vs. 0.05 ± 0.48 in the nonmidline shift group, p = 0.03).
  
  
  CONCLUSIONS
  For patients who underwent craniectomy, an improvement in neurological function 1 year after cranioplasty was observed. The patients with brain midline shift showed more improvement in consciousness after cranioplasty than those without a brain midline shift. The presence of a preoperative brain midline shift may be an isolated determinant for the prediction of the outcome after cranioplasty.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Chun-Hsien
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Ting-Chung
authors.initials: TC
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Martin Hsiu-Chu
authors.initials: MH
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Wan-Chun
authors.initials: WC
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan; Chang Gung Institute of Technology, Chia-Yi, Taiwan. Electronic address: ma2072@gmail.com.
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001930:Brain Injuries / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013624:Taiwan; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: brain midline shift; craniectomy; cranioplasty; neurological improvement